Pre-Operative Education
Hip Replacement and Knee Replacement
Patients and Family are encouraged to read prior to total hip or knee
replacement surgery.
Know what to expect before, during and after your procedure to:
• Prepare you for hospitalization
• Review daily routine &
rehabilitation
• Plan for discharge
Total Joint Replacement Pre-Operative Education
•
Arrange for help at home prior to surgery
– Who? Family, Friends, Neighbors – When? For 3-7 days after discharge
– Arrange for transportation to and from surgery
– Pre-cook meals, laundry, housekeeping/cleaning done
•
Purchase over the counter meds & equipment recommended by surgeon
•
Make appointment for preop Covid19 and MRSA test: 650-261-6864
•
Review all educational materials from surgeon office and hospital
Preparing for Surgery
• Check with your medical doctor regarding medications prior to surgery
• No anti-inflammatories 7 days prior to surgery
• No alcohol 3 days prior to surgery
• No shaving of your operative leg 5 days prior to surgery
• Chlorhexadine shower the night before — clean PJs & sheets!
Preparing for Surgery
• Hospital will call with surgery time the evening before (typically after 2:45pm)
• Nothing to eat after midnight! Your surgeon may encourage you to drink clear fluids (no jello) up to 2 hours prior to arrival to the hospital
• Bring comfortable clothes, shoes, insurance card, access to credit card#
if needed for
prescriptions/equipment, and a long phone charger cord if using cell
phone/tablet.
Preparing for Surgery
• Arrive 2 1/2 hours prior to surgery with a mask in place
• There is a parking garage to the right of the entrance
• Free valet service 0530 – 1400 Mon-Fri
Hospital Stay
• Enter through main hospital
entrance, mask will be given if you do not have one
• Please go to admitting/registration after meeting the entry screener where your temperature will be taken, continue straight down hallway on the right
• Visitors are not allowed past this point unless preapproved per hospital policy
Day of Surgery
Ambulatory Care Unit (ACU)
• Preparation by the nursing staff for surgery
• IV started
• Wipe/Scrub
• Surgical consent reviewed
• Surgeon & Anesthesiologist visit
• Identify Surgical Site
• Leave a contact phone number with the with nurse in ACU
Day of Surgery
Operation:
• 1-2 Hours for the operation only
• In the OR 2-3 hours total
Surgery
Anesthesia:
Anesthesia types will be discussed
with you by the anesthesiologist in the pre-surgery area.
• Spinal
• “Twilight”
• General Anesthetic
• Nerve Blocks for Knee Replacements
Surgery
PACU – Recovery Room:
• Typically, 1 Hour
• Wait for Spinal to end
• Monitor Vital Signs
• Drink fluids with head of bed up
After Surgery
Total joint center patient rooms are located on the 3rd floor.
• Patients requested to wear mask while in hospital
Patient Rooms
This will be taught in the hospital.
Please bring with you the day of surgery if received at preop
appointment.
• Reduces fevers
• Prevents pneumonia
• Bring home for continued use
Incentive Spirometer
Same Day Discharge:
• Some patients have been identified by the surgeon and
anesthesiologist to be appropriate for day of surgery discharge.
• Requirements:
– Medically stable
– Pain and Nausea managed
– Cleared by physical therapy and occupational therapy – Established safe discharge home
– Medications for discharge confirmed
Hospital Stay
For patients not discharged day of surgery Post-Op Day 1:
• Regular diet
• Drain removed if present
• Pain management
• Physical therapy – 2x
• Occupational therapy – 1x
• Total Joint Nurse Navigator visit to discuss discharge plans to home
Hospital Stay
For patients not discharged on post- op day 1
Post-Op Day 2:
• Pain management
• Physical therapy – 2x
• Occupational therapy – if needed
• Verify equipment needs
• Discharge home
Hospital Stay
• Early Ambulation – out of bed day of surgery
• Ankle pump exercises
• Sequential Compression Device (SCD)
• Blood Thinner determined by MD:
– Arixtra
– Lovenox injection (nursing will teach how to administer) – Warfarin
– Aspirin
Preventing Blood Clots
Cause:
•
Dehydration
•
Narcotics
•
Immobility Treatment:
•
Increase fluids 3 days before surgery and continue after discharge;
Mobility Medications:
•
Colace
•
Miralax (may begin 3-5 days before surgery; check with physician)
•
MOM – Milk of Magnesia
Constipation
• Tolerate regular diet
• Maintain stable vital signs
• Management of pain and swelling
• Increase independence with activity and mobility
• Confirmed safe discharge plan with staff
Requirements for Discharge
•
Narcotics – Discussed with you in MD office prior to surgery and confirmed prior to discharge from the hospital
•
Common medications for home include the following:
– Blood Thinner
– Anti-inflammatories and/or narcotics – Bowel Medications
– Nausea Medications
•
Return to Previous Medications
– Check with primary care physician if any changes should take place
For your education a medication brochure will be given to you while in the hospital which reviews medications purpose and potential side
Discharge Medications
Works on mobility such as walking with use of a walker, getting in/out of bed/chair, maneuvering up & down stairs.
Therapists will also review cold therapy and elevation techniques which reduce swelling and pain.
Physical Therapy
Works with activities of daily living (ADL) such as dressing, grooming, bathing and assist with determining additional needed equipment.
Occupational Therapy
• Optional equipment may be purchased before surgery. OT can teach how to use.
• Not covered by insurance
Occupational Therapy
• Your leg will be resting in a foam splint right after surgery. This will remind you not to cross your legs while in bed.
Positioning After Total Hip Replacement
• You will have some restrictions with mobility depending on how the surgery was performed. The need for continued restrictions will be discussed at your follow-up surgeon appointment.
Restrictions After Total Hip Replacement
Discharge planning is coordinated between you, your physician, therapist and other clinical staff with recommendations of
resources and needs post discharge
Care coordinator will help arrange for your discharge needs:
• Verify insurance coverage for services needed at discharge
• Order durable medical equipment
• Make referrals such as transportation home to assist if needed (ie for stairs or no access to ride home)
Discharge from the Hospital
Agencies, coverage and copay dependent on individual insurance plans Home health therapy:
•
Home health agency name and phone number will be provided before or after discharge to home. You will receive a call from the agency within 24-36 hours after discharge.
•
Home physical therapy (PT) and occupational therapy (OT) will make an in home initial assessment and make a recommendation of
treatment plan
– PT typically 2-3 times per week for 1-2 weeks depending on assessment of needs and insurance coverage
– OT typically one time visit
Outpatient Therapy:
Home Health and Outpatient Therapy
• If SNF is ordered by your physician, care coordination will assist with this preparation and insurance authorization
• ‘Skilled care” is health care given when you need skilled nursing or rehabilitation staff to treat, manage, observe, and evaluate your care on a daily basis
• Transportation to facility may or may not be covered by insurance
– Out of pocket costs approx $100 - $200
